Cardiovascular

Question 1

Course of action for a child presenting with a new murmur shortly after a period of viral illness

Answer 1

Examination
Reassure parent
Have child return for repeat cardiac examination when they are well
Even if still present reassure
If the child is WELL with the murmur, little action needs to be taken

Question 2

Characteristics of an innocent murmur

Answer 2

Soft
Systolic
Localised - no radiation
Alters with position/respiration

Question 3

What are the two main types of innocent murmur

Answer 3

Flow murmur - increased cardiac demand –> turbulent flow. Audible at LSE (Tricuspid)

Venous hum - children have larger head - so larger venous return through internal jugular veins –> flow murmur loudest under the clavicle. Disappears when lying flat

Question 4

Describe clinical features of patent ductus arteriosus

Answer 4

Left –> Right shunt from aorta into pulmonary arteries

Child will be SoB due to excess fluid on lungs

Bounding pulses
Continuous machinery murmur in infraclavicular area

Question 5

Management of Patent ductus arteriosus

Answer 5

Within first 3-4 days of life - ibuprofen may close it

Small PDA - usually asymptomatic
Large PDA –> will lead to FTT
–> diuretics, to enable feeding/growth
—> surgical ligation

Question 6

Describe characteristics of aortic coarctation

Answer 6

Systolic murmur in infraclavicular area - penetrates to the back
degree of obstruction influences severity of symptoms

–> RV and LV failure, pulmonary oedema, hepatomegaly

Question 7

Investigations for aortic coarctation

Answer 7

Radio - femoral delay
Radio - brachial delay
Blood pressure in all 4 limbs, or at least on the right hand side

Question 8

What is the most common congenital heart defect and what are the risk factors

Answer 8

VSD - most common

RF:
Trisomy’s (13/18/21), Turner’s, Foetal alcohol syndrome, Maternal diabetes

Question 9

Effects on the child of a large untreated VSD

Answer 9

Initially - Left –> Right shunt

 - -> overloaded RV --> pulmonary hypertension
           - --> fluid on lungs, SoB, LRTIs

After age 2 –> permanent pulmonary vasculature changes

- -> increased pulmonary vascular resistance
     - --> Shunt reverses, child becomes cyanotic and       very unwell

Question 10

Management of a child with VSD

Answer 10

Many close spontaneously within 2 years. Surgical closure before the age of 5

Surgery by 6 months if child is symptomatic, to avoid irreversible pulmonary HTN

Question 11

Which are the cyanotic/acyanotic congenital heart defects?

Answer 11

Acyanotic = ASD, AVSD, VSD

Cyanotic = Tetralogy of Fallot, transposition of the great arteries

Question 12

What are the acquired heart defects to be aware of?

Answer 12

Kawasaki disease –> coronary artery aneurysm

Rheumatic fever –> mitral valve disease